Introduction to azelaic acid
Azelaic acid is a naturally occurring acid that is by-product of Malassezia furfur, a yeast that can be found on skin. It has useful properties such as being anti-inflammatory, antimicrobial and being an antioxidant. These properties make it a useful ingredient for treating acne. On top of that, it can also help reduce pigmentation.
It is applied topically and is available in different formulations such as gels, creams and foams. Azelaic acid is available in different concentrations, with the concentrations such as 15% and 20% being prescription-only most, but not all, EU countries. Lower concentrations such as 10% are available over-the-counter.
How azelaic acid works
As mentioned earlier, azelaic acid has anti-inflammatory, antimicrobial and antioxidant properties. These properties make it a useful ingredient for treating acne.
Anti-inflammatory
First, it’s important to understand what causes excess inflammation. Inflammation is a natural response of the body to injury or infection. When your body or skin is inflamed, a protein called cytokines is produced.[1] This protein is a type of signaling molecule that helps your body regulate inflammation. The problem is that sometimes, the body can produce too much of this protein, leading to excess inflammation which is turn creates more redness or swelling in your skin. In this case, azelaic acid helps by reducing the production of cytokines, thus reducing the inflammation in your skin.
On top of that, azelaic acid can also help reduce the production of molecules known as reactive oxygen species (ROS)[2] that can damage the skin when it is inflamed. It does this buy keeping white blood cells in check, which can be responsible for producing ROS and causing extra damage such as swelling or pus.
Antimicrobial
One of the main bacteria involved in acne is called Propionibacterium acnes (P. acnes).[2] This bacteria lives on your skin and inside your pores. When it multiplies too much, it can lead to inflammation, which is one of the main causes of acne. Azelaic acid works by directly killing P. acnes bacteria or stopping their growth. By reducing the number of these bacteria on your skin, azelaic acid helps prevent them from triggering the inflammation that leads to acne lesions like pimples, papules, and pustules.
Antioxidant
Free radicals are unstable molecules[3] that can damage skin cells through a process called oxidative stress. This damage can lead to inflammation, premature aging, and worsening of skin conditions like acne. Azelaic acid acts as an antioxidant by neutralizing these free radicals, preventing them from harming your skin cells. By reducing oxidative stress, azelaic acid helps protect your skin from further damage and supports the healing process.
Summary
Azelaic acid is a useful ingredient for treating acne because of its anti-inflammatory, antimicrobial and antioxidant properties. It can help reduce inflammation, kill bacteria that cause acne, and protect skin cells from damage. By addressing these underlying causes of acne, azelaic acid can help improve the appearance of your skin and reduce the frequency and severity of breakouts.
